Orthostatic hypotension ups mortality risk in geriatric outpatients

Older outpatients with delayed/prolonged orthostatic hypotension (DPOH) are at higher risk of mortality, reveals a study. The magnitude of both systolic and diastolic OH is also associated with increased death.

This observational prospective cohort study examined the association in geriatric outpatients from the Amsterdam Ageing cohort and focused on OH duration and magnitude. OH was differentiated as either early (EOH) or delayed/prolonged.

The authors estimated the magnitude of drop in both systolic (SBP) and diastolic blood pressure (DBP) after either 1 or 3 min. They also collected mortality data from the Dutch municipal register.

The association between OH and mortality was determined using Cox proportional hazard models, adjusted for age and sex (model 1), as well as for OH-inducing drugs + SBP (model 2) and the presence of cardiovascular disease and diabetes (model 3). The authors also performed stratified analyses in patients with geriatric deficits.

Of the 1,240 patients (mean age 79.4 years, 52.6 percent women) included, 443 (34.9 percent) had OH: 148 (11.9 percent) had EOH and 285 (23 percent) DPOH.

A higher mortality risk was observed in geriatric patients with DPOH (hazard ratio, 1.69, 95 percent confidence interval, 1.28‒2.22), but not in those with EOH. The increased risk did not differ in patients with geriatric deficits. In addition, the magnitude of drop in both SBP and DBP correlated with an increased risk of mortality.

“Whether the duration of OH and magnitude of the drop in blood pressure is causally related to mortality risk or whether it is a sign of decreased resilience remains to be elucidated,” the authors said.